Osteoarthritis is one of the commonest problems and probably something that we will all face at some time, in one joint or another. Its impact on our lives can be significant with severe pain and immobility, or for some a nagging nuisance that stops you doing the things you enjoy – gardening or playing a whole round of golf. The principal symptoms are pain and stiffness, particularly in the morning, joint swelling and grating or grinding noises. The hips, knees, fingers and big toes are common sites, as well as the spine.
In general, we advocate conservative treatments initially which includes measures like physiotherapy, simple pain-killers, specific exercises and activity modification. Shock absorbing footwear or insoles may help, as might taking supplements of glucosamine and chondroitin – the building blocks of cartilage in joints. But when these have failed or symptoms are too severe what else can you do before considering surgery?
Fortunately, now there are a variety of injections that may help to keep you active. For some this may mean returning to full exercise, and for others it could mean deferring surgery. We still use corticosteroid injections when joints are acutely inflamed with lots of swelling and redness but this does not have a long term benefit and has more side effects. Consequently, we now offer treatment called viscosupplementation with a substance called Hyaluronic acid or Hyaluronans, which is the important substance in your natural synovial (joint) fluid. Injecting Hyaluronic acid in a gel-like form gives a highly viscous, lubricating fluid that coats the lining of the damaged joint surfaces and lining, reduces pain and protects the joint surfaces from joint inflammation. Our patients often refer to it as a version of WD40 for their joints.
At Sportswise we use a preparation called Ostenil Plus as it has a high concentration of hyaluronic acid and in our experience has very few side effects. For most joints it requires a course of 3 injections, each separated by a week, but this will depend on the individual and the joint involved. For the hip and shoulder joints we will use ultrasound guidance for the injection but for most others this is not necessary. There may be a little soreness at the time, as with any needle puncture, but this quickly settles and you can continue your usual activity the next day. There are very few side effects, as it is a naturally occurring substance in the body. A few people may have a slight allergic reaction which causes temporary pain and swelling in their joint after the injection which will settle with ice and paracetamol. There is also a small risk of infection with any injection, estimated at less than 1 in 20 000, but we have never had one at Sportswise in twenty years.
It is hard to predict how each patient will respond as this depends on many factors, including how well you look after your joint and whether you do strengthening exercises. Generally the improvement can be from 6-12 months to several years. We can monitor your progress through validated self-report questionnaires, with questions specific to the joint involved. This gives a score that can track your progress over time.
Please make an appointment to discuss it with one of our consultants if you want to find out more about osteoarthritis and the injections available.